05D1055441 CLIA NUMBER - CISCO MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 05D1055441
  • Facility Name: CISCO MEDICAL GROUP INC
  • Facility Address: 18518 SHERMAN WAY
    RESEDA, CA
    ZIP 91335
  • Facility Phone: 818 563-9571
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOSE F. MARTINEZ
  • NPI Number: 1164097341
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1055441
LAB Type Physician Office
Facility Name CISCO MEDICAL GROUP INC
Street 18518 SHERMAN WAY
City RESEDA
State CA
ZIP 91335
Phone 818 563-9571
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/16/2024
Certificate Expiration Date 6/15/2026
Facility Type Physician Office
Lab Director JOSE F. MARTINEZ

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This page was last updated on: 9/29/2025